WAIVER AND REALEASE OF LIABILITY FORM
RELEASE OF LIABIBLITY, WAIVE OF CLAIMS,
ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
BY SIGNING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL
RIGHTS, INCLUDING THE RIGHT TO SUE,
High Point Village, Inc.
PLEASE REVIEW CAREFULLY
ASSUMPTION OF RISK
1. I, the undersigned, wish to play at the Melonie Park, South Community Pool; I recognize and
understand that playing at the Swimming Pool involves certain risks. Those risks include, but are not
limited to, the risk of injury resulting from possible malfunction of the equipment used in the pool and
injuries resulting from tripping or falling over obstacles in the pool area Initial:_______
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT
In consideration of participating in the “Swimming Pool”, I hereby agree as follows:
1. TO WAIVE ANY AND ALL CLAIM that I have or may in the future have against High Point Village, Inc.,
their directors, officers, employees, agents and representatives (all of whom are hereinafter referred to
as “the Releasees”);
2. TO RELEASE THE RELEASEES from any and all liability for any loss, damage, injury or expense that I
may suffer or that my next of kin may suffer as a result of my participation at the Swimming Pool due to
any cause whatsoever, IN- Melonie Park, South Community Pool INCLUDING NEGLIGENCE ON THE PART
OF THE RELEASEES; High Point Village, Inc.
3. TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability from any damage to
property of, or personal injury to, any third party, resulting from my participation at the Swimming Pool;
4. That this Agreement shall be effective and binding upon my heirs, next of kin, executors,
administrators and assigns, in the event of death.
I HAVE READ AND UNDERSTOOD THIS AGREEMENT, AND I AM AWARE THAT BY SIGNING THIS AGREEMENT
I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND
ASSIGNS MAY HAVE AGAINST THE RELEASEES.
______________________________________
_______________________________
Participant (Please print name clearly)
Date of Birth
___________________________________________________________________________
Address Parent/Guardian if participant is less than 18
________________________________________________
_______________________
City/State/Postal Code
Phone
______________________________________
Participant’s Signature
Witness
Swimming Pool Waiver |High Point Village, Inc. |Lubbock, TX 79464 | (806)698.0015